Avoid Draconian Settlements, Investigations with Proactive Compliance

There is a popular adage often attributed to Benjamin Franklin, the father of time management, noting that "failing to plan is planning to fail." The phrase has been utilized many times in many different venues over the years.

But does it apply to compliance programs in healthcare today? I would suggest that it absolutely does. Many compliance-related settlements or investigations are a result of organizations and/or individuals not taking the time to plan appropriately for the inherent risks of the marketplace.

As a veteran of healthcare compliance, I am often asked about what advice I would give to new compliance officers, board members, and CEOs regarding how best to organize their compliance programs. Another question I often hear is this: How can I organize my program to reduce the potential of a financially draconian settlement and/or a long, expensive investigation? My response usually begins by focusing on two general themes:

Make sure your compliance program is proactive and not reactive.

Instill in your corporate culture that compliance is an investment and not an expense.

Here are some suggestions to have several aspects of your compliance program conform to these themes:

Auditing and Monitoring

Develop an annual work plan for all of your anticipated audits and reviews to be performed. Incorporate good planning practices to develop the work plan, based upon the results of past reviews, anticipated new risk areas, review of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) work plan, and other intelligence.

Don’t wait for a problem to occur to begin your reviews. Monitor the completion of these reviews throughout the appropriate time period and regularly report on progress to the compliance and/or audit committee(s). Ensure that paybacks and corrective actions related to findings are occurring in a timely fashion.

Determine in advance those reviews that will require outside consultant assistance due to a lack of internal staff expertise or bandwidth. If you are having difficulty in completing your work plan, then you have identified an opportunity to improve your compliance program.

Education

Plan in advance your compliance education training. Incorporate your content settlements that have made national and local news and are applicable to your organization. Educate staff on your corrective actions that have been taken as a result of “good compliance” and are consistent with your culture of compliance.

Preach that compliance is viewed as a key component of your organization’s culture and an investment, not an expense. Consider utilizing an external compliance expert to share insights and experiences. Don’t forget to talk about the basic tenets/elements of your compliance program, and try to make the content interesting for the audience.

Video segments (with proper approvals) focusing on compliance settlements are a great way to keep the audience engaged. Don’t forget to ask for feedback; there are simple ways to do this, such as handing each participant an index card to confidentially communicate their thoughts and concerns.

Budgeting

Too many times executives are not focused on investing in their compliance program. Rather, they see it merely as an expense. If compliance is an important part of your organizational structure, you should be consistently looking for tools and resources to minimize the risk of whistleblower complaints, False Claim Act cases, Stark Law/Anti-Kickback Statute risks, expensive defense fees, and reputational harm. And yes, these tools will cost money!

Compliance Officer

Make sure you have someone with the proper experience, expertise, and moxie to perform this difficult job.

Compliance Staff

Make sure you are staffed appropriately, with the proper skill sets to manage all of the risks in your organization, and proactively protect your assets via best practices.

Contract Management

Make sure contracts are automated to track, monitor, and assess what is going on in each high-risk area. Technology exists to dramatically reduce risk and increase efficiencies.

Hotline

Outsource this function and promote to your staff, vendors, etc. that they can place calls regarding matters of concern without fear of retaliation.

Paybacks

When a determination is made that overpayments need to be made, do it within 60 days and develop a mechanism to track that you have actually made paybacks. This is a great way to show that you are embracing compliance.

Avoid circumstances in which other influential people in the organization try to bully you or attempt to “opinion shop” for consultants who will give a different audit result. Once a decision has been made by compliance, respect the decision and move forward with the payback.

All of the above aspects of your compliance program can benefit by proactive planning.

A veteran in healthcare compliance (since 1997), Bret Bissey has served as senior vice president and chief ethics compliance officer at UMDNJ in Northern New Jersey. The author of the Compliance Officer’s Handbook, he has been a thought leader and popular speaker at industry conferences and meetings for many years. Bissey has more than 30 years of diversified healthcare management, operations, consulting, and compliance experience.

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